Sunday, August 26, 2007

Free-Lunch Healthcare

In my last post Free-Market Healthcare for Dummies, conservative blogger Jim Campbell who hosts a blog with the snappy title: U.S. Health Care System is the Best in the World. But it Could be a bit Better left me a comment, saying:
Dude: You are seriously funny. Talk about somebody that has no clue about what he is talking about? You take the cake. I challenge you to go to my website Unlike you, I'm not in the attack mode, I've matured to understand that in the U.S. we can do it better...

And what was it that I wrote that was wrong? I have no idea. He wouldn't tell me. Instead, he insults me for being clueless, tells me I'm in "attack mode," and implies that I'm immature. Yet unlike me, he's not in attack mode. Right. We've had a few exchanges since then, and his insults have just gotten thicker.

In fact, Jim has now written a total of six comments on that post, and yet has still failed to explain anything he thinks I was wrong about. Instead, he seems to believe it's simply a matter of insulting me enough until it finally sinks in. His last comment included a reposting of Stossel's entire piece. And let me tell you, that really did it. I now see the err of my ways. All it took was for him to repeat himself enough times without ever explaining anything. And it worked. I'm now a convert.

And this reminds me of something I wrote in the post he hated so much.
But with conservatism egging them on, they bound ass-first into a world they haven’t the ability or inclination to understand. Rather than ever attempting to find out what the hell is going on, they prefer instead to tell everyone else what’s going on and act really annoyed when nobody else knows what the hell they’re talking about.

It seems Jim Campbell has set-out to prove me right on that one. Thanks Jim, but it really wasn't necessary.

Constructive Insults

And I'll admit it, I insulted John Stossel, as well as many conservatives. I do that all the time and have no problem with it. After all, conservatives almost never read my insult, so I'm not really being rude. And beyond that, I always explain why I'm insulting them. This isn't just "John Stossel is a poopy head" stuff. Or "I'm better than Jim Campbell, the clueless attack dog". I always explain what I'm talking about. That's what this blog is about.

And what's worse is when guys like Jim don't even understand how rude they are. When they denounce us for throwing insults, but throw insults at us to do it. And if we return fire, they seem honestly surprised by the natural reaction they get, as they have no clue as to how they appear to other people. They'd need empathy for that kind of thing, and that's not really their strong suit.

I'll admit that Jim's comments weren't the rudest I've read, but it always bugs me when I get insulted without any explanation for why I'm being insulted. And hell, while I insult people, I generally avoid doing so if I think the person I'm talking about might read it. I'll insult John Stossel because he's not likely to read this stuff. But I'm much less likely to insult Jim, as he's likely to read this. (Hi Jim!)

And just to show what a nice guy I am, I'll go ahead and perform my magic on one of his posts. This is for you, Jim. A demonstration on how it's done. Unfortunately, there wasn't too much for me to critique him on, as much of the post I chose is little more than pixie dust and wishful thinking. But I've found it difficult to get much more than that out of any conservative. Once you brush aside the huff and fantasy, there really isn't much left behind.

Vouching for our Healthcare

Jim has a post titled Health Care Vouchers: a Market-Based Approach that Would Cost Nothing, in which he explains his way of solving our healthcare problem. And what is it? As far as I can tell, it involves having the government give us tax credits to cover the cost of purchasing insurance from insurance companies. These credits would not only be a dollar-for-dollar reimbursement for the insurance, but would even go towards people who paid no income tax. This is, of course, in contrast to Giuliani's lame scheme, which was only a tax exemption, and not a tax credit.

Of course, I've never really understood this approach. Why the middle-man? Insurance companies have many expenses that the government doesn't have. Is it really possible that they're so much more efficient that it more than offsets the cost of these extra expenses? I find that doubtful. But if someone can show me how this is true, I really might warm-up to this voucher approach.

But one thing is clear: Jim's post did absolutely nothing to show me otherwise, and that's really what he needed to do to make his point. And I have an admission, I had a really difficult time understanding what Jim was saying. So it's quite possible that I'm making some big mistakes in my analysis. But as I said in the previous post, conservatives usually only make sense to themselves, so it's quite likely he really isn't making sense.

My Analysis

And regarding his voucher system, I'm not necessarily against it. I play no favorites and will support anything that provides decent healthcare for everyone. I've got a pretty good insurance plan now, but I've gone without any insurance, and it totally sucks. But before I'll sign on with his plan, he needs to show how it's a better system than what we could have from other systems; including the "Socialized Medicine" approach he's so against. So is it? Based on his post, I have no idea.

First off, I don't see how this wouldn't be hugely expensive. As it is, the government allows businesses to deduct health insurance premiums as they do with other business expenses. But instead, it looks like Jim wants the government to absorb the entire cost, which would be hugely expensive. And then he wants to add insurance coverage to the uninsured, which would surely be even more expensive.

So how much would all this cost? I have no idea. Jim never says. He's advocating a position, yet is entirely fuzzy on any details. He doesn't even give a ballpark figure for how expensive this would be. The only assurance he gives is that it won't cost more than what the government is already paying. Having read his post, I feel less than assured.

Covering Everyone

As he says:
This would not cost taxpayers a dime because Medicare, Medicaid, government employee plans and the corporate tax deduction exceed the total cost of a tax credit that would cover everyone.

Ok, well that explains everything...wait a minute! It explains nothing. Unless I'm just completely missing the mark, there's no way he's correct. Or if he is, he didn't bother explaining how this could be possible. Before he can assert that this won't cost us a dime, he needs to give us the numbers for Medicare, Medicaid, government employee plans, and corporate tax deductions; as well as giving us a ballpark figure for how much his plan is going to cost us. I'm not asking for a detailed breakdown; but he needs to give us something to go on. Otherwise, his plan sounds like complete fantasy; which I think it is.

The only number he provides regarding this is when he suggests that we could afford $7500 per person and still be cheaper than what we're currently doing. Yet my calculation of that amount, based on a rounded 300 million citizens, comes out at $2.25 trillion a year. This compares to $784 billion he cites for Medicare and Medicaid, and he never mentions how much the government pays for anything else. But unless it's more than $1.47 trillion, he's totally wrong.

To be honest, I have no idea if this is what Jim is really saying. All I'm saying is that I read his post, I'm a smart guy, and this is the best I could do. And I strongly suspect that I am getting this right and that Jim's the one who's confused on this.

It seems that most of Jim's point rests on the assumption that insurance companies always do things better than the government. It's just one of those magical things that must be true. This is so obvious, in fact, that he never has to explain how any of this works. Jim needs only to assert that insurance companies would have magical savings, and we're not even supposed to question any of this. It's not just that we'd get better healthcare, but it would cost us nothing more than what we pay now...if only we trusted the free-markets instead of the blasted government.

That's not to say that Jim doesn't provide other numbers. But I didn't understand what they said or why he provided them.

Apples & Oranges

One big mistake seems to be that he compares things that are so dissimilar that they cannot be compared. For instance, in a later post, he blasts the Canadian system for not providing care that is as good as ours. And while it's possible that our system is superior, we'd never know. Because we spend WAAAY more per person than the Canadians do, and it's quite possible that if they spent as much as we did, their system could be as good, or better.

I don't have the time to find the most recent numbers, but this PDF from the Kaiser Family Foundation (p.4) shows that we spent $6037 per person in 2004. In contrast, the Canadian system that he dogs so hard spent a mere $3161 per person; $2876 less than what we spend per person. Yes, we spent almost twice what they spent. Yet I'm not sure if Jim ever mentions this extremely crucial fact.

Now, maybe it truly is our free-market competition that allows us to reign supreme over Canada's monopoly healthcare; but I suspect that this spending difference might be part of the story. Can anyone really suggest that Canada's system wouldn't improve if it spent as much per person as we did? Of course not. So why is he comparing us to Canada? If anything, there's this hidden assumption in his posts as if the Canadian system is more expensive than ours; or even comparable in price. But it obviously isn't. We pay almost twice as much per person, yet many Americans still lack basic health insurance and only seek medical attention in dire emergencies.

And again, this seems to go unmentioned in his posts on Canada's system; at least in the handful of posts I read. Yet I don't see how you can discuss the issue properly without mentioning the spending differences.

At this point, I feel compelled to explain that I have not, I repeat not offered a justification of Canada's system, nor attacked our own. I have merely shown a gaping flaw in Jim's thinking. And there's nothing wrong with that. It's what I do.

Apples and Orangutans

Getting back to his voucher post, he starts crunching some numbers on how much we spend on Medicaid and Medicare. But for the life of me, I can't fathom why he crunches these numbers. I think he was trying to show us how expensive Medicaid and Medicare are. And so he's trying to show us how much we spend on these programs per capita.

But for this to make sense, he'd need to show how much we spent per recipient. But he doesn't. He shows us how much each citizen pays for these programs. We comes out with $784 billion in spending divided by 305 million people; giving $2570 per capita. But how is that a meaningful number? What does it have to do with anything? Again, this number isn't how much we're paying for each person to be in these programs. It's how much each American pays for the programs. Huh?

My only guess is that he crunched the wrong number, as he seems to then try to compare this number with an estimate that Cigna Insurance gave him a few months back. They apparently quoted him a rate of $2376 that an individual could get insurance. But again, he's not using the same basis for this number as the previous one, so these aren't even close to being comparable.

And beyond that, what does this anonymous Cigna plan cover? Is it comparable to Medicaid or Medicare? Could an elderly person with cancer get this plan? I find that extremely doubtful. Does it have a huge deductible that Medicaid doesn't? Probably. But Jim never mentions any of this. He just tosses out some unnamed insurance plan and tries to compare it with Medicare/Medicaid numbers that aren't comparable.

I'm honestly having trouble grasping how any "expert" could make these glaring mistakes.

If All Else Fails, Attack Michael Moore

He even then tries to compare his Medicare/Medicaid numbers with Cuba's $250 per capita healthcare spending. Yet I think that covers all Cubans, and not merely the people in a certain program. So again, he's using the wrong number if he's trying to compare Medicaid/Medicare with Cuba. And honestly, this whole Cuba thing had nothing to do with his voucher plan, and just seemed like an unnecessary attack on Democrats and the dreaded Michael Moore. As if he's got such a case of Michael Moore Fever that he has trouble talking about healthcare without bashing the guy.

His whole point on this is to attack Moore for saying we don't do enough to help our poor people; as compared with how much Cuba pays. But these systems aren't comparable by price. You'd have to compare these by the level of health of the recipients; not by the dollars spent. So his unnecessary attack on Democrats and Michael Moore isn't even valid. If Cuba can provide comparable health for less money, that still doesn't mean that we're providing good enough healthcare for our poor people. Particularly in that our health system is money-based, and Cuba's isn't.

In our system, good healthcare is expensive. And people like John Stossel and Jim Campbell like it that way, and consider it a huge plus. They want the newest technology and expensive drugs, and they're perfectly happy with paying profits to middlemen for processing our paperwork. And they hate the idea that the government could cap how much they'll pay for a service or drugs. But then they get all confused by the fact that our system is so expensive and when people complain that they can't afford it. Well, with the good comes the bad. Deal with it.

Soaring Costs

He also quotes Newsmax saying:
"The soaring costs of Medicaid - which will more than double this year to close to $330 billion since 1999 - is largely due to legislation that extended Medicaid coverage to many Americans who have low-paying jobs."

Oh, no! Medicaid costs are now soaring because it's covering more people. Now, I suppose that's a valid argument for someone who doesn't think poor people deserve good health or should be alive; ie, the typical Newsmax reader. But if you're trying to cover all citizens, as Jim is trying to do, then the costs will "soar" even more. It's as if Jim didn't understand why Newsmax was saying Medicaid costs were soaring, and imagined it was due to bureaucratic waste, rather than the reason Newsmax said it soared. But believe it or not, if Medicaid covers more people, it will cost more. Just as it costs will soar under Jim's plan.

It really seems as if Jim doesn't understand why conservatives hate Medicaid and Medicare. It's not that they think the government is bad at providing healthcare (though they also think that). It's that they just don't want to have to pay for other people's healthcare and are perfectly fine if people get sick and die. The whole talk about "free markets" and being "cost conscious" are just rationalizations to attack the basic principle: They don't give a damn about other people and don't want to pay for their healthcare. That's all this is really about.

Yet that's the main point of Jim's healthcare plan. He's planning to have the government cover EVERYONE'S healthcare. Heck, even I don't think that's necessary, and I'm a devout liberal. I'm willing to accept it if that's our best option, but Jim's got a lot more work to do to make me a believer.

Apples to Apples

At this point, I'd like to show Jim what his post should have said. To make his point that we should switch to vouchers, he needs to first show us how much the government currently spends on healthcare. Then he needs to show us how much it would cost the government to pay for these insurance plans. And this insurance would have to be comparable to what Medicaid and Medicare cover; and not some unnamed plan from Cigna that certainly wouldn't apply to most Medicare recipients. We also need to be sure that old people and the chronically ill aren't forced to pay more than they currently pay.

And if he wants to include magical free-market savings, he needs to give us some ballpark figures for how much he's talking about in savings and to explain why these are realistic numbers and not magical. I'm not asking for too much. Just some facts to back-up his assertions. In other words, if he thinks we can afford the $2.25 trillion plan I think he was suggesting, he needs to explain how that's possible.

And that's all his post needs to say. It doesn't need to mention Cuba or Michael Moore. Nor does it need to show how much we're spending on Medicaid and Medicare per American. He just needs to show us that his system can provide decent medical coverage to everyone at a reasonable price. It's that simple and is the minimum he can provide for him to make his argument. And it's obvious that he failed to do that in his post.

Proved my Point

But as things are, Jim seems to have confirmed exactly what I was saying about conservatives. He's mimicking what real people do, providing numbers and suggestions and whatnot, but none of it makes any sense. He never explains the parts that need to be explained, and includes unnecessary attacks. Yet because he calls it a "market based approach" and insists it's a free lunch, I'm sure many conservatives will find his argument undeniable. It just feels right.

Well, except for the fact that these people don't want to pay for other people's insurance, so I really don't know how well this will go over with conservatives either. Overall, it seems like he picked this simply as an alternative to the dreaded "Socialized Medicine" he's so intent on stopping. If anything, I could imagine him as a liberal pretending to be a Socialized Medicine basher who hates Hillary, Michael Moore, and Canada in order to get conservatives to take their medicine. And if that's the case, the guy's a lot smarter than I've given him credit for. But he'd still need to provide better numbers.

And the weirdest thing about all this is that, if his plan was as inexpensive as he asserts it is, I don't think anyone would object to it. It's so obvious, in fact, that I find it impossible that it isn't already being done if it could be. Hell, not only is this a free lunch, he's throwing in a week's worth of desserts. Even the insurance companies would love it. How could it be that nobody figured this out before?

And it's my guess that nobody figured it out because it doesn't work. And if Jim actually provided the basic numbers he needs to provide, I'm sure he'd figure that out too. As usual, a conservative sees the free-market as some sort of magical free-lunch that has huge benefits and little downside. We just tighten our belt a little, add some competition into the works, get rid of those "unnecessary treatments and bureaucracy" and viola!, healthcare for everyone.

Free-Magic System

Another thing to highlight is the reason why it's so difficult to understand conservatives. Because they have so many hidden assumptions, which are often entirely baseless, that you really can't follow their "logic" at all. Only people that also have these hidden assumptions can understand what they're trying to say. But they never make these assumptions explicit. Nor can they. If they actually said these things outloud, they'd get totally laughed at. And even still, they get laughed at. They just make lots of bold assertions without any regard for having to explain any of them, and don't understand why we can't understand their undeniable logic.

And Jim's post was a perfect example of that. He tosses out a few meaningless numbers, makes lots of baseless assertions, and imagines that he's designed some awesome healthcare plan that will solve everything for less money than we spend now. As I said in my last post, these people don't even really seem able to grasp what the free-market is, beyond some all-purpose magic theory that solves any problem you want solved.

For John Stossel, it means that you need to make people pay for more of their own medical bills. For Jim Campbell, it means that you can pay for everyone's healthcare for less money than you pay for a smaller group's healthcare. In both cases, the free-market solves the exact problem they want solved. Magic!

In Jim's defense, he at least has huge improvements over the idiot John Stossel's argument, who refused to even acknowledge that lack of healthcare was a problem; as well as failing to understand how his "solution" would only make that problem worse. And that's a huge first hurdle for conservatives to get over. But now we've just got to get Jim passed the idea of the free lunch.

Sorry Jim, but the free-market ain't free. We can give everyone healthcare, but someone's going to have to pay for it. But I'd be happy to have him prove me wrong.


Jim Campbell said...

Hey: You have totally misrepresented everthing on my page. I don't claim to have a plan, I'm looking for one since it seem we are going to have one forced upon us? Document anything from my site the indicates that I have any idea what the final proposals should look like? I don't like where we are headed. In keep faith with your opinion of me, I'm certain you never learned critical thinking skills. Go to bed and suck your thumb. ;-) J.C.

laughingman said...

Sorry, Jim. I read as much of your page as I could, and I think Doc Biobrain is right on the money. If he's not, why don't you explain what he misrepresented instead of challenging his critical thinking skills?

Doc has gone over, in amazing detail, what problems he has with the arguments you have made here and at your site and has even offered you ways you might convince him of your point. If you can't do that, you need to concede the rhetorical field. Honestly, I'm getting a little embarrassed for you.

Unlike you, Jim, I have actual experience in "socialized medicine." I lived in Britain in my early 20s and used the NHS for both acute and preventative care. I got good care at no out-of-pocket costs, with a lot less paperwork. My taxes were a little higher, but as Doc said, there is no such thing as a free lunch.

Doctor Biobrain said...

Jim - You don't have a plan?!? Then you've certainly perpetrated a massive fraud on your readers. I wouldn't doubt at all that a sympathetic reader might assume you're making a real proposal that could work. You really should have labeled your work the fraud it really is. But even still, the numbers you gave don't make any sense, even if you don't call it a "plan".

And like Laughingman, I really don't understand what your hang-up with socialized medicine is. I've had good insurance and I've had crappy insurance. I've also had my kids on the CHIP program here in Texas, at a time when I couldn't get employer-paid insurance. And I can assure you that the CHIP program was no worse than the best insurance I've had, and it was certainly better than the crappy insurance I had, which kept dicking me over on everything and lying to me.

The only thing I didn't like about CHIP was when they started getting chintzy by instituting co-pays and forcing people to re-apply every six months. But it worked great at the beginning. And the co-pays were the same as what I pay now for my good insurance. It was just like any other insurance program, except that I didn't have to pay for it. I really don't understand what your problem with it is.

whig said...

Seems to me that open-enrollment Medicare for all without premium would be the best solution. Nobody is forced to drop private coverage but it would be hard to justify unless they provide a lot more services, but they are already adapting and offering alternative health care options for members, nutrition counseling, etc.

John of the Dead said...

The conservative free-market theories are a lot like the Underpants Gnomes:

Phase One: Free Markets

Phase Two: ???

Phase Three: Desired Outcome!